Can the insurance company claim it is pre-existing?

I had a life insurance policy through my job on me and my spouseeach year at annual enrollment i would raise it to next level. Last year an they refuse to pay? I have had this policy for 4 years they never requested a medical release on him just on me,which I passed.

Asked on May 21, 2009 under Insurance Law, Texas


FreeAdvice Contributing Attorney / FreeAdvice Contributing Attorney

Answered 11 years ago | Contributor

Let's make sure what you are talking about. You said life insurance, but people do not collect on life insurance until there is a death, and obviously you are alive and I hope your spouse is too.

If you are asking whether because you are increasing the amount of optional coverage you buy a the worksite, IF someone dies can the insurance company claim that there was a medical condition you did not disclose, and thus deny benefits, the answer is it all depends on what the application or form you signed when increasing coverage says.

Most employer provided group insurance is issued to actively at work employees and no evidence of insurability is required, no medical questionnaire is used, etc.  In many places the spouse is eligible for the same benefit, with no medical information required.

In some circumstances the optional life insurance is medically underwritten. To be eligible the employee, and spouse, have to complete an application with medical questions and then undergo underwriting. A material misstatement would be grounds to deny coverage if the death occurs within 2 years from policy issue.

If this does not address the matter you asked about, please resubmit your question.

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